In short
Balance naturally changes with age as the inner ear, vision, sensation and strength decline. More than one in four adults aged 65 and older falls each year, but many falls are preventable. A balance assessment finds your specific risks, and a targeted exercise program lowers them.
Reviewed by Dr. Manan Patel, PT, DPT, TPS. Updated October 17, 2026.
Common symptoms
- Feeling unsteady when walking, turning or in the dark
- A fall or near-fall in the past year
- Fear of falling that limits what you do
- Holding onto furniture or walls for support
Not sure this matches? Take the 60-second dizziness self-check.
What causes balance and falls?
Falls usually have more than one cause: inner-ear changes, weaker legs, vision changes, reduced feeling in the feet, medications that cause drowsiness or low blood pressure, and hazards at home.
BPPV is a common, easily treated cause of unsteadiness in older adults that is often missed. People with weakness in both inner ears, known as bilateral vestibular hypofunction, have an especially high fall risk.
How we test
Your first visit is a full 60-minute, 1-on-1 evaluation, and treatment often starts the same day. Depending on your symptoms, testing can include:
- Standardized balance and walking tests
- Inner-ear screening, including for BPPV, which is often missed in older adults
- Strength and sensation testing
- A home-safety review
Why Balance Changes with Age
Maintaining upright stability requires a real-time neurological partnership between your inner-ear vestibular sensors, vision, foot/joint proprioception, and lower-body reaction speed. With age, gradual hair-cell loss in the inner ear (presbyvestibulopathy), diminished ankle proprioception, and slower postural reflexes combine to dramatically increase fall risk.
The Hidden Danger: Undiagnosed BPPV in Older Adults
Clinical studies show that up to 9% to 11% of older adults with unexplained unsteadiness actually have undiagnosed Benign Paroxysmal Positional Vertigo (BPPV) without classic spinning sensations. We screen every senior balance patient with Infrared Video Goggles so hidden inner-ear crystal issues are cleared immediately.
What Our Vestibular & Balance Clinic Does Differently
- Infrared Video Goggles (VNG) & BioSway Fall-Risk MappingWe objectively test your inner-ear reflexes and measure your exact limits of stability and sway velocity to pinpoint why you feel unsteady.
- Comprehensive Fall & Risk AssessmentsWe offer comprehensive Fall & Risk Assessments to help identify your personal risk factors and develop a tailored prevention strategy. Our expert team uses state-of-the-art technology and evidence-based practices to evaluate your balance, strength, and overall fall risk.
- Vestibulospinal Conditioning & Home Safety GuidanceTargeted lower-extremity power, gaze stability, and practical household fall-proofing to preserve long-term independence.
Ready to Reclaim Your Balance & Confidence?
Looking for relief? Schedule a 60-minute 1-on-1 evaluation at our Alpharetta Clinic (Inside GBSPT) or our Cumming Clinic, or call (470) 380-7007.
Your treatment plan
Find your risks
Testing shows which systems, such as inner ear, vision, sensation or strength, are contributing to unsteadiness.
Balance and strength training
Progressive balance, walking and leg-strength exercises, the approach with the strongest evidence for preventing falls.
Confidence and home safety
Practical changes at home and a routine you can keep up long term.
Recovery and what to expect
A large Cochrane review found that exercise programs combining balance and functional training reduce the rate of falls in older adults. Medicare covers medically necessary physical therapy, and we are in-network with Medicare.
Tips for daily life
- Remove loose rugs and clutter from walkways
- Add grab bars and night lights
- Have your vision checked every year
- Ask your doctor or pharmacist to review medications that can affect balance
When to get urgent care
Questions about balance and falls
Am I too old to improve my balance?
No. Balance improves with training at any age.
Do I need a referral?
No. Georgia allows direct access to physical therapy, though some insurance plans have their own rules.
Related guides
- Fall prevention at home: a balance and safety checklistAn interactive home safety checklist, and the exercise research that lowers fall risk.4 min read · Patients and families
- Vertigo, dizziness or lightheadedness? How to tell the differenceWhat spinning, rocking, woozy and faint usually mean, and when dizziness is an emergency.4 min read · Patients
Browse all guides in our learning center
Related conditions
- Bilateral hypofunction (BVH)Reduced balance-sensor function in both inner ears.
- BPPV (positional vertigo)Brief, intense spinning when you turn in bed or look up.
- Unilateral hypofunction (UVH)Weakness in one inner ear, often after a viral infection.
- Vestibular rehabilitationHow testing and treatment work for every type of dizziness.
References
- Sherrington C, et al. Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews. 2019.
- Centers for Disease Control and Prevention. STEADI: Stopping Elderly Accidents, Deaths & Injuries.
Where to get treated
Book at either clinic. Same phone number, same team, same 60-minute visits.
Cumming clinic
Off GA-400 Exit 13 on Peachtree Parkway
Cumming, GA 30041
Alpharetta clinic
Inside Georgia Brain & Spine Physical Therapy
Alpharetta, GA 30022
Also serving Johns Creek, Milton, Roswell, Suwanee and nearby communities.
